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| 罗库溴铵用于不同烧伤程度患者的肌松效应 |
| Effect of rocuronium in patients with different degrees of burn injury |
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| DOI：10.12089/jca.2020.08.001 |
| 中文关键词: 烧伤 罗库溴铵 肌松效应 肌松残余 |
| 英文关键词: Burn Rocuronium Muscle relaxant effect Residual paralysis |
| 基金项目:国家自然科学基金（81760248，81960250）；云南省高层次人才培养（D-201632）；云南产业技术领军人才培养（YLXL20170054）；俞卫锋专家工作站（2017IC067）；云南省应用基础研究联合项目[2017FE468(-034)]；云南省教育厅科学研究基金（2019J1250）；昆明医科大学研究生创新基金（2019S030） |
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| 中文摘要: |
目的 观察和比较罗库溴铵用于不同烧伤程度患者的肌松效应。
方法 选择择期手术患者115例，男81例，女34例，年龄18～55岁，BMI 18.5～24.9 kg/m2，ASA Ⅰ—Ⅲ级，其中非烧伤骨科患者30例作为对照组；烧伤手术患者85例，根据烧伤程度分为三组：轻度烧伤组(n=29)、中度烧伤组(n=28)及重度烧伤组(n=28)。患者入室后连接肌松监测仪，持续监测拇内收肌肌颤抽搐反应。静脉推注罗库溴铵0.9 mg/kg后，记录肌松起效时间、气管插管条件及临床作用时间。当T1恢复至基础值的25%时，追加罗库溴铵0.3 mg/kg，直至最后一次追加罗库溴铵后，记录肌松恢复指数、95%恢复时间及术后肌松蓄积残余发生情况。
结果 轻、中、重度烧伤组的肌松起效时间明显长于对照组（P<0.01）。中、重度烧伤组的临床作用时间明显短于对照组（P<0.05）。重度烧伤组的肌松临床作用时间明显长于轻、中度烧伤组（P<0.05）。中、重度烧伤组的肌松恢复指数、95%恢复时间明显短于对照组（P<0.05）。重度烧伤组的肌松恢复指数、95%恢复时间明显长于轻、中度烧伤组（P<0.05）。重度烧伤组出现2例（7%）苏醒延迟，5例（18%）拔管后呼吸抑制。
结论 临床麻醉工作中应根据患者烧伤程度的不同而调整罗库溴铵的用量，以维持良好的肌松效果以及减少术后肌松残余。 |
| 英文摘要: |
Objective To investigate and compare the effect of rocuronium in patients with different degrees of burn.
Methods A total of 115 patients, aged 18-55 years, ASA physical status Ⅰ-Ⅲ, and with a BMI 18.5-24.9 kg/m2 were selected. Among them, 30 non-burned patients were selected as the control group, while 85 burned patients were selected as the test group. According to the degrees of burn, burned patients were divided into three groups, which were mild burn injury group (n = 29), major burn injury group (n = 28), and severe burn injury group (n = 28). The muscle relaxation monitor was prepared to monitor the twitch response of adductor hallucis. After rocuronium 0.9 mg/kg was injected, the onset time of muscle relaxation, clinical meantain time and tracheal intubation condition were recorded. When the T1 of TOF value returned to 25%, rocuronium 0.3 mg/kg was added. When rocuronium was given for the last time, recovery index, 95% recovery time and postoperative residual muscle relaxation were recorded.
Results The onset time of muscle relaxants in the mild, the major, and the severe burn injury groups were prolonged than that in the control group (P < 0.01). The clinical maintenance time in the major burn and the severe burn injury groups were shorter than that in the control group (P < 0.05). Compared with the mild and the major burn injury groups, the maintaining time was prolonged in severe burn injury group (P < 0.05). Both recovery index and 95% recovery time in the major and the severe burn injury groups were shorter than that in the control group (P < 0.05). Compared with the mild and the major burn injury groups, the recovery index and 95% recovery time were prolonged in severe burn injury group (P < 0.05). There were 2 (7%) patients in delayed recovery from anesthesia and 5 (18%) patients in respiratory depression.
Conclusion Dosage of rocuronium should be adjusted properly according to the different degree of burn in clinical anesthesia so that to maintain better muscle relaxant effect and reduce postoperative residual complications of muscle relaxation. |
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